Minerva ginecologica最新文献

{"title":"Ultrasound before operative vaginal delivery: why and how.","authors":"B. Kahrs","doi":"10.23736/S0026-4784.20.04667-5","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04667-5","url":null,"abstract":"Safe management of the second stage of labor is important. Wait for spontaneous delivery, operative vaginal deliveries and second stage cesarean sections are all options when prolonged second stage occurs. The important question is which option to choose. Fetal head station and fetal head position are used to decide mode of delivery, this has traditionally been decided by performing a digital vaginal examination. Studies have shown that theses clinical examinations of both fetal head station and position are unreliable and that ultrasound might be better option. The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) published in 2018 guidelines on intrapartum ultrasound and recommends that ultrasound is performed for ascertainment of fetal head position and station before considering or performing an instrumental vaginal delivery for slow progress or arrested labor in the second stage. The determination of the fetal head position, fetal head station and the movement of the fetal head can easily be determined with the help of ultrasound and can help the clinicians in making the right decision on how to proceed when prolonged second stage of labor is diagnosed.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2020-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49505765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal heart rate monitoring in labor: from pattern recognition to fetal physiology.","authors":"M. Oikonomou, E. Chandraharan","doi":"10.23736/S0026-4784.20.04666-3","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04666-3","url":null,"abstract":"The journey of human labour involves hypoxic and mechanical stresses as a result of progressively increasing frequency, duration and strength of uterine contractions and resultant compression of umbilical cord. In addition, occlusion of the spiral arteries during myometrial contractions also leads to repetitive interruptions in the utero-placental circulation, predisposing a fetus to progressively worsening hypoxic stress as the labour progresses. The vast majority of fetuses are equipped with compensatory mechanisms to withstand these hypoxic and mechanical stresses. They emerge unharmed at birth. However, some fetuses may sustain an antenatal injury or experience a chronic utero-placental insufficiency prior to the onset of labour. These may impair the fetus to compensate for the ongoing hypoxic stress secondary to ongoing uterine contractions. Non-hypoxic pathways of neurological damage such as chorioamnionitis, fetal anaemia or an acute fetal hypovolemia may potentiate fetal neurological injury, especially if in the presence of a superimposed, additional hypoxic stress. The use of utero-tonic agents to induce or augment labour may increase the risk of hypoxic-ischaemic injury. Clinicians need to move away from \"pattern recognition\" guidelines (\"Normal\", \"Suspicious\", \"Pathological\"), and apply the knowledge of fetal physiology to differentiate fetal compensation from decompensation. Individualization of care is essential to optimize outcomes.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45824821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrapartum Doppler ultrasound.","authors":"A. Dall'asta, T. Ghi, I. Mappa, P. Maqina, T. Frusca, G. Rizzo","doi":"10.23736/S0026-4784.20.04698-5","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04698-5","url":null,"abstract":"Intrapartum hypoxic events most commonly occur in low-risk pregnancies with appropriately grown fetuses. Continuous intrapartum monitoring by means of cardiotocography has not demonstrated a reduction in the frequency of adverse perinatal outcome but has been linked with an increase in the caesarean section rate, particularly among women considered at low risk. Available evidence from the literature suggests that abnormalities in the uterine artery Doppler and in the ratio between fetal cerebral and umbilical Doppler (i.e. cerebroplacental ratio, CPR) are associated with conditions of subclinical placental function occurring in fetuses who have failed to achieve their growth potential regardless of their actual size. In this review we summarize the available evidence on the use of intrapartum Doppler ultrasound for the fetal surveillance during labour and the identification of the fetuses at risk of intrapartum distress.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2020-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44709875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation for intrapartum care - from training to novel device innovation.","authors":"E. Hotton, M. Merialdi, J. Crofts","doi":"10.23736/S0026-4784.20.04669-9","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04669-9","url":null,"abstract":"Improving maternal and perinatal care is a global priority. Simulation training and novel applications of simulation for intrapartum care may help to reduce preventable deaths worldwide. Evaluation studies have published details of the effectiveness of simulation training for obstetric emergencies, exploring clinical and non-clinical factors as well as the impact on patient outcomes (both maternal and neonatal). This review summarises the many uses of simulation in obstetric emergencies from training to assessment. It also describes the adaption of training in low-resource settings and the evidence behind the equipment recommended to support simulation training. The review then discusses more novel applications for simulation such as its use in the development of a new device for assisted vaginal birth and its potential role in Caesarean section training. It further discusses the financial implications of simulation training and how this may impact the delivery of such training packages. It presents a concept that simulation should be developed and utilised as a key tool in the development of safe intrapartum care in both emergency and non-emergency settings, in innovation and product development.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44782589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between cervical excisional treatment for CIN and obstetrical outcome.","authors":"M. Monti, Debora D’aniello, A. Scopelliti, V. Tibaldi, G. Santangelo, V. Colagiovanni, A. Giannini, V. Di Donato, I. Palaia, G. Perniola, A. Giancotti, L. Muzii, P. Benedetti Panici","doi":"10.23736/S0026-4784.20.04678-X","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04678-X","url":null,"abstract":"OBJECTIVE\u0000The aim of our systematic review is the assessment of effects of excisional treatments for the management of cervical intraepithelial neoplasia (CIN) on preterm delivery (PD), lower birth weight (LBW), preterm premature rupture of membrane (PPROM) and obstetrical outcomes.\u0000\u0000\u0000METHODS\u0000A structured search was carried out in PubMed-Medline, Embase, and Cochrane Controlled Trials Register databases through November 30, 2019. The search included a combination of the following terms:\" Loop Electrosurgical Excision Procedure LEEP\",\" Large Loop Excision of Transformation Zone LLETZ \",\" Cold-Knife Conization CKC\",\" Laser Cervical Conization CLC\", \"preterm delivery\" and \"neonatal outcome\".\u0000\u0000\u0000RESULTS\u0000Thirty-two (32) of 561 publications considered were included: 28 retrospective series, 2 prospective studies and 2 multicenter trials. Globally in several studies there was a significant increase in PD, measured by the relative risk, in the women underwent a surgical procedure for the CIN. In their majority, the studies were retrospective and therefore a high risk of bias.\u0000\u0000\u0000CONCLUSIONS\u0000This systematic review shows that the surgical treatment of the CIN was associated with an increased risk of PD, LBW and pPROM before 37 pregnancy weeks compared to untreated women, especially in a CKC and LLETZ procedure. Moreover, the increase of the of PD was associated with cone size, cervical length, repeated treatment and a short conization-to-pregnancy interval.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2020-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68827149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on surgical treatment of female stress urinary incontinence.","authors":"M. Monti, M. Fischetti, A. Di Pinto, G. Santangelo, A. Giannini, O. D’Oria, T. Golia D’Augè, Fabiana Carbone, G. Perniola, V. Di Donato, I. Palaia, L. Muzii, P. Benedetti Panici","doi":"10.23736/S0026-4784.20.04658-4","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04658-4","url":null,"abstract":"BACKGROUND\u0000Urinary incontinence is a common condition that negatively impacts quality of life of millions women.It's a result of a synergy between the structures of pelvic floor in particular levator ani muscle and pelvic connective tissues. Urinary incontinence,increasing with age, is associated with considerable personal and societal expenditure.\u0000\u0000\u0000METHODS\u0000Systematic data search performed using PubMed/MEDLINE database up to August 20, 2020. Focus was only for English language publications of original studies on urinary incontinence and in particular stress urinary incontinence.\u0000\u0000\u0000RESULTS\u0000Given the basis of published evidence and the consensus of European experts, this study provides an updated overview on clinical applications and surgical procedures of urinary incontinence.\u0000\u0000\u0000CONCLUSIONS\u0000Urinary incontinence is an underestimated health problem. Many surgical options exist for women with stress urinary incontinence. Nevertheless new strategies need to be evaluated in order to improve quality of life of patients.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2020-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46641741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction of endometriosis-related pain: efficacy of trace elements in a double-blind, randomized, placebo-controlled trial.","authors":"Pierre Mares, Audrey Pivano, Auréa Cophignon, Renaud Urbinelli, Aubert Agostini-Ferrandes","doi":"10.23736/S0026-4784.20.04538-4","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04538-4","url":null,"abstract":"","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":"349-350"},"PeriodicalIF":1.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38221756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BRCA1/2 genes mutations, ovarian reserve and female reproductive outcomes: a systematic review of the literature.","authors":"Lucia Merlino,&nbsp;Alessandra Chiné,&nbsp;Cecilia Galli,&nbsp;Maria G Piccioni","doi":"10.23736/S0026-4784.20.04624-9","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04624-9","url":null,"abstract":"<p><strong>Introduction: </strong>BRCA1 and BRCA2 genes mutations seems to impact female fertility, in addition to increasing the risk of ovarian and breast cancer. Several studies had investigated this issue but data available are still controversial. In order to clarify the role of BRCA1 and BRCA2 mutations in female fertility and ovarian function we carried out a systematic review of the literature with the aim to establish a possible management's strategy of these patients.</p><p><strong>Evidence acquisition: </strong>A review of current literature regarding BRCA mutation (BRCAm) and fertility was conducted using the PubMed tool to select remarkable articles with the keywords \"BRCA1/2 gene,\" \"BRCA1/2 mutation,\" \"anti-Müllerian hormone,\" \"female fertility,\" \"ovarian reserve\" and \"premature ovarian failure.\"</p><p><strong>Evidence synthesis: </strong>In current literature there are controversial findings about the relation between BRCA genes mutations and lifespan of female reproductive age. Several studies showed an higher risk of premature ovarian insufficiency of BRCAs mutations carriers, according to lower serum AMH level, primordial follicle count, or fewer oocyte yield after ovarian stimulation; on the other hand more recent studies reported not significant differences in serum AMH level or in reproductive outcomes between mutated and non-mutated BRCA patients. For this reason, currently there is not a strict recommendation for routine evaluation of fertility in female carriers of BRCA mutations. Nevertheless, the strong advice to complete childbearing by age 40 and then to undergo a risk-reducing salpingo-oophorectomy and the increased risk of infertility as a result of anticancer treatment in breast cancer BRCAm patients, make the issue of fertility and pregnancy planning in these women worthy of consideration.</p><p><strong>Conclusions: </strong>A dedicated counseling to discuss these issues, eventually associated with a personalized assessment of serum AMH or antral follicle count in order to have a panoramic view of ovarian reserve, may be useful in the management of these patients.</p>","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":"339-348"},"PeriodicalIF":1.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38229835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Advisory Board Italiano sulla sindrome dell'ovaio policistico (PCOS): dalle osservazioni all'esperienze cliniche sull'uso del mioinositolo (MYO) e dell'acido alfa-lipoico (ALA) per migliorare i quadri della sindrome].","authors":"Enrico M Ferrazzi,&nbsp;Paolo Moghetti,&nbsp;Franca Fruzzetti,&nbsp;Alessandra Gambineri,&nbsp;Anna Maria Fulghesu,&nbsp;Maria E Street,&nbsp;Rocco Rago,&nbsp;Irene Cetin,&nbsp;Chiara Mandò,&nbsp;Nicoletta Di Simone,&nbsp;Alessandro D Genazzani,&nbsp;Rosanna Apa,&nbsp;Vincenzo De Leo","doi":"10.23736/S0026-4784.20.04575-X","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04575-X","url":null,"abstract":"appare contribuire a sua volta alla patogenesi dell’insulinoresistenza e pu(cid:122) verosimilmente contribuire anche ad alterare la clearance dell’insulina, con la produzione di circoli viziosi che tendo - no ad amplificare le relazioni fra questi aspetti. L’insulinoresistenza pu(cid:122) essere misurata appropriatamente e direttamente utilizzando la tecnica del clamp euglicemico iperinsulinemico, che non è per(cid:122) applicabile nella routine clinica. Sfortu - natamente, gli indici surrogati usati in questo contesto sono gravati da importanti limiti e in particolare da un elevato numero di falsi negativi. Anche per quanto riguarda l’iperandrogenismo esistono rilevanti problematiche che limitano la possibilità di misurare con precisione questi ormoni nella comune pratica clinica. In accordo con le evidenze sul ruolo importante dell’insulinoresistenza in questa sindrome, la metformina, farmaco insulino-sensibilizzante, pu(cid:122) migliorare gli aspetti riproduttivi della sindrome in circa il (cid:24)(cid:19)(cid:8) delle pazienti. (cid:39)ati preliminari suggeriscono che anche l’inositolo possa svolgere effetti positivi sotto questo profilo, ma i dati sono ancora insufficienti e devono essere confermati da studi appropriatamente disegnati, alcuni in corso.","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":" ","pages":"239-284"},"PeriodicalIF":1.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38715503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic office hysteroscopy with the Storz TrophyScope® versus Cooper surgical Endosee®.","authors":"Mateo G Leon,&nbsp;Andrew Nguyen,&nbsp;Alex Nguyen,&nbsp;Tri A Dinh,&nbsp;Christopher C Destephano","doi":"10.23736/S0026-4784.20.04568-2","DOIUrl":"https://doi.org/10.23736/S0026-4784.20.04568-2","url":null,"abstract":"<p><strong>Background: </strong>Office hysteroscopy (OH) is becoming increasingly popular. Our objective was to determine the use patterns, reported pain scores, and success rates of OH with the 2.9 mm Storz TrophyScope^® and handheld portable Cooper surgical Endosee^® device in a clinic without previous office hysteroscopy experience.</p><p><strong>Methods: </strong>A prospective cohort study of a hysteroscopy quality improvement database was conducted in a tertiary care center gynecology clinic. Patients undergoing OH with either the Storz TrophyScope^® or Cooper Surgical Endosee^® device were included.</p><p><strong>Results: </strong>Of the 171 office hysteroscopies, 77 utilized the TrophyScope^®, with 8 (10%) being inadequate, while 94 utilized Endosee^®, with 13 (14%) being inadequate (P=0.50). Of the 13 inadequate Endosee^® hysteroscopies, 4 (31%) were due to visualization, 4 (31%) to patient intolerance, 3 (23%) to cervical stenosis, and 2 (15%) to a combination of these factors. Of the 8 inadequate TrophyScope^® hysteroscopies, 7 (87%) were due to patient intolerance and 1 (13%) to cervical stenosis. Of the 150 adequate office procedures performed, 52 cases underwent subsequent procedures in the operating room (OR). Of these, 26 (84%) of 31 Endosee^® cases and 18 (86%) of 21 TrophyScope^® cases were in agreement with OR procedure findings. A subgroup analysis comparing mean pain levels did not significantly differ between the two hysteroscopes.</p><p><strong>Conclusions: </strong>There was no difference in accuracy with OR pathologic diagnoses, adequacy of procedure, and reported pain scores when comparing the TrophyScope® and Endosee® in this prospective cohort. Larger studies are needed to confirm the sensitivity, and specificity for these newer, disposable office hysteroscopic devices.</p>","PeriodicalId":18745,"journal":{"name":"Minerva ginecologica","volume":"72 5","pages":"310-315"},"PeriodicalIF":1.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10772986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}